Pursuing Better Outcomes in Obstructive Colorectal Cancer Surgery: A New Predictive Scoring System for Immediate...

Colorectal cancer (CRC) is one of the most common cancers occurring globally. Surgery for CRC often extends hospital stays due to complications, as patients must meet nutritional needs and regain mobility before discharge. Longer hospital stays, required for extended monitoring and care, can increase the risk of further complications, creating a cycle where extended stays lead to more issues. Predicting a patient's length of stay (LOS) is crucial for optimal resource management, financial control, and patient care.

This study aimed to create a scoring system to predict postoperative complications and prolonged hospitalization in colorectal cancer surgery patients. Over 60 variables, including age, BMI, and tumor location, were analyzed for their correlation with complications.

A complication score was developed based on six factors linked to postoperative complications: hemoglobin (Hb), serum albumin, tumor localization, EC (epidural catheter), opioid use, and NPO (nil per os) days. Patients with three or more identified risk factors had a 6.17-fold higher complication rate, with a highly significant p-value of 0.0008, demonstrating the score's strong potential for identifying high-risk patients. The factors significantly associated with length of stay (LOS) include admission hemoglobin levels, tumor localization (right versus left colon), intraoperative fluid intake, the presence or absence of regional anesthesia and analgesia (RAA), the number of drainage tubes, and postoperative hematocrit levels. The analysis shows that patients with at least three of the six identified risk factors are 5.17 times more likely to experience prolonged hospitalization (over eight days) compared to those with fewer than three points, with a statistically significant correlation (p-value of 0.003). Our findings indicate that patients with three or more risk factors are significantly more likely to experience complications and extended hospital stays.

This scoring system can serve as an essential tool for healthcare providers to identify at-risk patients, optimize resource allocation, and ultimately enhance patient recovery and outcomes. Moreover, the integration of the complication and LOS scores into routine preoperative assessments can facilitate a more personalized care plan, enabling healthcare providers to identify patients who may benefit from closer monitoring and additional support during their recovery. Further validation in diverse populations and settings is needed to confirm the scoring system's generalizability and utility.